Edward Balls: Of course I will not, because I did not mislead the House last week. I have looked at  Hansard, and I said clearly that although I accept that Leicestershire has a lower spending level per pupil than other areas, it will have the 34th largest increase in spending in the next three years. It was in our statement to the House, and it is clearly shown in  Hansard. The thing that surprises me about today's motion is that it does not mention any of the reforms that we have been putting in place over the past 10 years. It does not mention numeracy and literacy; more teachers; more than 1,000 new schools; new disciplinary powers for head teachers; or the fact that more than 85 per cent. of schools are now called specialist schools. It does not point out that over the past 10 years we have delivered rising standards year on year or that we have reduced the number of schools not getting a quarter of their pupils to five good GCSEs from 616 at the end of the Conservative Government in 1997 to just 26 today.

Rob Marris: Does my right hon. Friend agree that the motion demonstrates the lack of knowledge and the bankruptcy of Conservative policy on schools? The motion is headed "Government policy on schools reform". Despite that, it does not contain a single word on the primary schools sector, which the majority of pupils in the state sector attend. That shows that the Conservatives know nothing about where our kids go to school.

Edward Balls: I have already taken many interventions. Let me turn to the point at which things will get particularly interesting for Opposition Members. The hon. Member for Surrey Heath has come forward with a proposal to create 220,000 new school places. To be fair to him, he has told us how he will pay for it. Yesterday he said in black and white in his policy document that the Conservatives would pay for it with a £4.5 billion cut from our building schools for the future programme, which will rebuild or refurbish every secondary school in England over the next 10 years. However, the Conservatives said that they would honour existing commitments under BSF. The impact of the new academies would therefore apply to those waves where commitments have not yet been made, which would be concentrated on the 76 local authority areas in BSF wave 7 onwards that are not yet engaged in BSF.

David Laws: I am sure that you are quite right, Mr. Deputy Speaker, and one of the things that I learnt at the Phoenix school in west London this morning was the importance of leadership in maintaining good order, without which we learn nothing, and I should have thought that the Secretary of State recognised that observation.
	Let me raise with the Secretary of State some specific points about the Government's position on academies, given that it is obvious that he has been nudging away from structural reform and that he has been continuing the policy, which he and the Prime Minister had before the new Prime Minister took over, of being far more resistant and sceptical about public sector reform than the previous Prime Minister.
	The Secretary of State has not yet answered a number of important questions about the delivery unit report. In particular, can he let us know whether Lord Adonis was involved in the seminar on 1 November to establish the review? Can he tell us which academies will be reviewed by the delivery unit? I believe that five academies will be reviewed in particular.  [ Interruption. ] The Secretary of State from a sedentary position says, "All of them." Is he really suggesting that the delivery unit will go around in a few weeks and look at 83 academies? Why does  The Times Educational Supplement say this week that the unit will look at five specific academies, including Knight's academy in London? If there is a shortlist of those that will be looked at, can we know about it?
	On the crucial issue of local authorities, I have been clear about my concern that the Government are getting the involvement of local authorities completely wrong in the academies programme. Ultimately, it seems nonsense that hundreds of schools in the maintained sector could have accountability that will bypass local authorities altogether and that there will be no strategic control. However, the Secretary of State appears to be trying to make it easier for some bodies to involve themselves in the academies programme. To the extent that that is bringing new structural reform and new people into the education system who are aspirational, particularly about schools that have large numbers of deprived pupils, that is very welcome, but we want to be sure that that does not actually involve a reverse takeover of the academies programme, so that the Secretary of State can say that he has got 400, 500 or 600 academies, when their power to innovate and to do things that they cannot do in the maintained sector is compromised.

Barry Sheerman: My hon. Friend is a welcome new member of our Committee, but if he looks back at my remarks he will see that I was talking about the last education debate. For me, today's debate is much better—it is about academies. That was just a warning shot. I do not like it when we say that everything is bad and is going to hell in a handcart. It is not.
	We on the Select Committee have always tried, even when the hon. Member for East Worthing and Shoreham (Tim Loughton) was a member, to judge the Government by certain standards, one of which is evidence-based policy. Opposition parties should be judged on evidence-based policy, too. When it comes to the evidence-based policy for the recent foray into early years education, I am critical of my Front Bench and the Opposition Front Bench, who are both getting it wrong because of their passionate love affair with synthetic phonics. The Select Committee inquiry found that any systematic way of teaching children to read worked.
	The problem was a lack of any system in too many schools. Indeed, when we went further, we found that the real trouble was that teachers were not taught to teach children to read. We made two strong recommendations. First, we said that we should ensure that teachers are trained to teach whatever system they choose, or whatever is in fashion—and it is very much a question of fashion. Secondly, we said that we should be very careful when extrapolating from the evidence of one piece of research in one part of the United Kingdom—Clackmannanshire. In a sense, I am disappointed with both the Government and the Opposition.

Barry Sheerman: In a minute; let me develop my argument.
	Opposition Front Benchers say that a dramatic change is occurring in the Government's attitude to academies. So far, I have not seen that, and I spend a lot of time talking to the Specialist Schools and Academies Trust, many of the major sponsors and academies themselves. I try to keep my finger on the pulse of what is happening in academies. I do not see, and they do not seem to perceive, a radical change in the academy programme, or restrictions being put on them. The suggestion is that heavy emphasis is being put back on the dead-weight hand of local authorities. After years as Chair of the Select Committee on Children—[Hon. Members: "Schools and Families."]—Schools and Families; sorry, someone was passing me something. With my experience as Chair of the Committee, I do not see academies being put at risk by local government.
	However, there is a problem. Time and again, in every inquiry we undertook, parents, head teachers and people in the education sector and in schools said, "Give us a good, supportive, well-informed, local authority in partnership with us; that is our best option." That is what they crave, and even those places that do not have that relationship would like it. In a sense, getting that balance right is one of the responsibilities of any Government.
	We cannot deny local democracy, although it is sometimes awkward. Councillors make decisions that others do not like. When the Liberal Democrats were in charge of Kirklees, they set their face against academies. I was quietly talking about the possibility of an academy or two in Kirklees and Huddersfield, but I could not get anywhere when the Liberal Democrats were in charge. Two councillors changed in the local elections, and we now have a Conservative-led administration that is in favour of academies, and I support that. Local democracy is like that, and we have to live with it. Sometimes, local authorities are so bad on education and delivery that pretty dramatic action has to be taken. I can name cases in Yorkshire and across the country where such dramatic action was necessary, and education in those areas is much better for it.
	There is an unfair, biased balloting system for grammar schools, so why not have a fair balloting system when a local authority says that it does not want an academy, but local people might do so? We have told the Government that it would be good if we had a fair balloting system for selective schools instead of the present rules, under which any proposal for change is defeated. A balloting system might not be bad; I just put that idea in the ears of the Minister for Schools. It could apply to schools that want to become academies and schools that want not to be grammar schools. It would be a more even-handed approach, but I am not sure how quickly he will grasp it.
	I want to say something supportive about academies. Evidence given to our Committee suggests that academies have shown steady improvement, but there will be some challenges. I was interested to hear the caution of the Liberal Democrat spokesman, the hon. Member for Yeovil (Mr. Laws), on banding. In our inquiries on admissions, head teacher after head teacher said, "If we had a school intake that represented our community, we could do wonderful things," but what happens if everyone who can do so moves to a better catchment area, or puts their children into independent education?
	I visited a secondary modern school in Kent where 100 per cent. of the pupils received free school meals, 65 per cent. had special educational needs and there were many looked-after children. With such an imbalance, it is extremely difficult to do a good job for all the children, no matter how charismatic the head. Of course, if children go to a selective school in Kent, they will do well and get a good education, but the majority of pupils who do not get into the grammar schools get a poor education, so on average all children in Kent get a sub-standard education. That is an interesting effect of selection.
	The hon. Member for Yeovil responded to an intervention about faith schools. The Committee found that one problem with faith schools was that they did not tend to reflect their community. Ironically, according to their charters, many of our greatest public schools—set up many years ago by kings, queens and notable politicians, if one is prepared to dig back that far—were established for the education of poor children. They are hardly in that business now.

David Chaytor: My hon. Friend makes an important point. That is the hidden agenda, and we could see that from the expression on the shadow Secretary of State's face. Throughout his speech, he found it extremely difficult to keep a straight face, in his new-born commitment to liberal, progressive modernity. Indeed, I would go further back. The shadow Secretary of State spoke about the miraculous assumptions of some aspects of Government policy, but he was the personification of miraculous assumptions, in what he was saying about the way forward. He combined that with a kind of immaculate conception. It was almost as if Keith Joseph had come back to speak to us. Indeed, there was nothing that he said with which Keith Joseph would have disagreed.
	It seems to me—I am looking to the hon. Member for Bognor Regis and Littlehampton (Mr. Gibb) to clarify this, because he is a thoughtful Member of Parliament—that the Conservatives' approach is riddled with contradictions. On the one hand, they keep telling us that they want to give more freedom to schools and head teachers, pass down more power to parents, lift the dead hand of bureaucracy, move away from the command economy and take centralisation out of the system. On the other hand, they want to tell every pupil in the country that they must keep their shirts firmly tucked in their trousers and every teacher that every time anyone walks through their classroom door, every child in that classroom must—day in, day out, week in, week out, month in, month out—stand to attention. That is a level of prescription that Joseph Stalin could not have dreamed of, and it blows out of the water any commitment to trusting the professional judgment of teachers and head teachers that the Conservatives want us to believe they support.

David Chaytor: I understand that perfectly, because that has been the case since the passing of the Education Reform Act 1988. The only people who seem to think that local authorities run every school are the Liberal Democrats and the Conservatives. Certainly nobody on the Government Benches thinks that that is how the system in this country could reasonably be described.
	I should like to say a word or two about choice and selection. The ground of this debate, which has been going on for 40 years or more, fundamentally shifted when the hon. Member for Havant (Mr. Willetts) made his speech earlier this year. Only last week, in the debate on the Loyal Address, I was able to read the key extract of his speech, in which he finally admitted that a selective admissions policy—selection by academic ability—entrenches disadvantage rather than eroding it. From that moment on, regardless of the divisions in the Conservative party, the ground of the debate shifted. I welcome the fact that the Opposition have included in their motion a clear commitment to
	"all-ability schools in the state sector",
	albeit in their call for new providers to open them. I also welcome the clear commitment in the Liberal Democrats' amendment to eliminating selection by various means.
	However, we have to be clear about the issue of choice. It is a simple matter: either we want schools to choose pupils through various forms of selection, such as academic selection, which exists in some areas, selection by aptitude or a variety of fairly dubious proxies, or we want parents to be able to choose schools. I am firmly on the latter side of the argument. However, we must accept that the historical legacy of the location of our schools and the distribution of population mean that it is logistically impossible for every parent in the country to secure their first choice school, unless the Government are committed to a massive expansion in their budgets, to keep thousands and thousands of spare places open.
	We heard from the official Opposition yesterday that they are doing precisely the opposite, because they intend to take a huge slice—I think that the figure was £4.5 billion—out of the building schools for the future programme. They have to understand that choice can operate only in a fair, balanced and regulated framework, where the objective is to ensure that parents secure their first choice school, but where that is balanced by other factors. Otherwise, the exercise of choice by some individuals can, if not operating in a fair framework, simply mean the denial of choice to others. It is the central role of the Government and of local authorities to ensure that we have that fair and balanced framework, which maximises choice to the benefit of the greatest number of parents.
	I should like to make a point about good schools and good GCSEs. A comment that I have made to a number of Ministers for education is that although the Government have been extremely successful in driving up standards over a 10-year period and in enabling thousands of young people to obtain qualifications that they would not have obtained before—it really is as simple as that—the focus on good GCSEs nevertheless has a downside. The target of 5 A to C grades has a general level of support, but every time we describe such grades as good GCSEs, we are saying to the young people who do not achieve them that their GCSEs are somehow no good, and that they have failed miserably to achieve what we expect of them. We are sending that message not only to those young people, but to their parents. I have discussed this point with my hon. Friend the Minister for Schools and Learners, and with his predecessors, but I would like to appeal again for a different way to describe levels of achievement. I am not talking about manipulating targets—targets are important and I want to see results improving year on year, and to see children achieving more year on year—but we have to find a different kind of language.
	We have to find a different kind of language to describe schools as well. It is too easy just to talk about a good school. In my experience—I think most Ofsted inspectors would agree with this—there are good schools, but most schools are good at something. To assume that there is a category of schools defined as good and another that is defined as failing is utterly simplistic and does not accurately describe what is taking place. Furthermore, we all too often fall into the trap of defining a school as good because it happens to have a favourable intake. Again, I ask the Government to revisit the kind of language that we use. We need to find a better, richer language to describe the range of schools that we have, their many qualities and the many ways in which they advance the education and achievement of their pupils.
	In respect of language, I should also like to make a point about the 14-to-19 diplomas. In the Queen's Speech debate last week, I made an appeal for us to look again at Sir Mike Tomlinson's original report on the relationship between A-levels, GCSEs and the new diplomas. I now want to ask my hon. Friend the Minister to think again about the use of the words "vocational" and "academic". In theory, there is cross-party consensus that we need to bridge the academic-vocational divide. In my view, however, that will not be achieved as long as we continue to use the terms "vocational" and "academic". Again, we need a richer, more careful language to describe the range of subjects in the curriculum, and the range of knowledge and skills that young people require to pursue different careers.
	For example, we can ask the simple question: is maths an academic subject or a vocational subject? For someone going to university to do a degree in maths, physics or information technology, maths is an academic subject. However, for someone training to be an electrician, a plumber or a joiner, it is vocational. This is an issue for all Members of the House, head teachers, teachers and parents, and we really need to revisit it, to determine the best way of describing the range of subjects, knowledge and skills in the curriculum. I have noticed the word "applied" creeping into recent speeches. Perhaps the terms "theoretical" and "applied" would provide better ways of achieving this.
	I want to touch briefly on the subject of special educational needs. Reference has been made by other hon. Members to the Select Committee's report on SEN, which I believe moved the debate forward a little. I still think that we have a major problem with statementing, however. The noble Baroness Warnock's speech two years ago calling for a rethink on statementing and on the categorisation of SEN was really important. I am not sure that the Select Committee—of which I was then a member—or the Government's response have fully taken that report on board.
	The basic principle should be that, in reality, the vast majority of children have special educational needs of one kind or another. For many children, those needs will be fairly minor, but they need to be recognised none the less. By focusing on SEN as a distinct category of people with highly visible disabilities, and on the statementing process, we have overlooked the less dramatic, less obvious needs of large numbers of children who nevertheless need a little more attention than the present system can provide.
	Finally, I should like to put three questions to my hon. Friend the Minister. First, is it the case that, as the schools commissioner goes round the country looking at local authorities' plans for building schools for the future, he is requiring the authorities to adopt academies if they are going to secure BSF money? If that is the case, it needs to be made public and a matter of policy. If it is being done quietly, on the side, I do not believe that that is the best way of handling this matter. My own local authority might well be interested in having an academy in the near future, but that is a decision that should be taken locally. It should not involve a bit of arm-twisting by the schools commissioner.
	Secondly, will my hon. Friend tell us how far the Department has got with the commitment that was made some weeks ago to review the ballot system for wholly selective schools? As he will know, this is an issue of great importance to me and to many other Members, and the Government need to keep us informed about it, and to consult widely on improvements to the present ballot arrangements. Thirdly, will my hon. Friend confirm the ongoing importance of the historic commitment made by the Prime Minister, when he was Chancellor, not only to narrow the gap between per-pupil funding in state schools and that in private schools, but to close it? Will my hon. Friend also tell us in what time scale he thinks it would be feasible to achieve that?

Graham Stuart: It is a pleasure to follow the hon. Member for Bury, North (Mr. Chaytor), whose knowledge of and commitment to education are widely recognised. To pick up on his question, it would be fascinating to hear from the Minister whether the present Prime Minister's promise was just spin and whether there is a timetable for fulfilling that commitment. The hon. Member for Bury, North will acknowledge that it would be fantastic if the Minister could do that, but I fear he will not.
	It is a pleasure to take part in this debate. The Conservative motion is extremely positive about the academies programme. It offers the new, young Secretary of State the opportunity to remove some of the kinks in his policy-making, and to give the programme his full backing. The word "choice" came out of his mouth as though it were a swear word; he just about managed to utter it, but not with any real enthusiasm. Instead, astonishingly, he spent almost all his speech attacking the Conservatives for proposing such a positive motion in support of what we hope will be an ongoing academies programme, building on the many achievements of the previous Conservative Government.
	A Liberal MP, William Forster, drafted the Education Act 1870, and a Conservative politician, Rab Butler, introduced the Education Act 1944, which made secondary education free of charge for all pupils, so let no one doubt that the Conservatives care passionately about the start in life that our younger people, from all backgrounds, experience. That is why we put country before party and voted for the Education and Inspections Act 2006, and why we published yesterday's green paper a full two years before the expected date of the general election. On matters of such importance, we are always prepared to put country before party and to work with the Government to do the right thing.
	I challenge the Minister to face down those on his Back Benches, and in too many Labour-run local authorities, who do not back the academies programme. I think that the hon. Member for Bury, North's enthusiasm is somewhat muted, although he did not elaborate on that today. I should be happy to take an intervention if he wants to show that enthusiasm, which I hope the whole House would be able to express today.
	I shall concentrate on social mobility, which is the reason we need educational reform. The record of successive Governments, as a body of evidence shows, has been poor. A 2005 study by the London School of Economics compared the life chances of British children with those of children in the US, Canada, Germany, Norway, Denmark, Sweden and Finland. It examined the extent to which childhood circumstances influenced adult economic success. Social mobility was found to be greatest in Norway and Sweden, and Canada and Germany also did well. It was virtually static in the US, and the gap in opportunities between the rich and poor in Britain was found to be widening.
	I give the Government credit for doubling in real terms—certainly in cash terms—the amount spent on education, but the social outcomes for which incoming Ministers might have hoped in 1997 have not been delivered. That is why we need reform. That is why we need the positive approach of Conservative Front Benchers, who say that we must extend the academies programme to make choice real, while also allowing the establishment of new schools. We must allow charities and other groups to set up new schools. Otherwise, the supply system of choice will be taken over entirely by middle-class parents, using their ability to work the system to the benefit of their children, and we will not have the uplift for those from deprived areas that the whole House sincerely wants.

Jim Knight: It is a pleasure, as ever, to respond to another debate on schools reform. A bit like Tory flip-flops on school policy, they come around fairly regularly these days.
	The debate has been illuminating on an Opposition motion that is a bit like the schools policy they announced yesterday—as much about what it does not say as about what it says. There was nothing about early years learning at one end or how to tackle the problems of those not staying on at the other. There was nothing on ending the divide between vocational and academic learning that my hon. Friend the Member for Bury, North (Mr. Chaytor) talked about. There was nothing on narrowing the attainment gaps between boys and girls, people of different ethnicity and people with different educational needs. There was no judgment from the hon. Member for Surrey Heath (Michael Gove), no vision—just froth. There were no answers to the challenges our country faces and no policies to build on the steady improvements in education over the past 10 years.
	The motion is all about academies because the Conservatives want to talk about their brave new policy on new academies—a policy funded by a smash and grab raid on our programme to replace every secondary school in the country. They would take more than £4.5 billion from the building schools for the future programme and create uncertainty for two thirds of the schools in England about whether they would be the one in seven left out of that transformational programme. Which five of the 34 secondary schools in Dorset will miss out? Which of the 33 in Oxfordshire, or the 40 in West Sussex? Will the hon. Member for Surrey Heath tell his constituents which seven of the 53 secondary schools in Surrey will not be rebuilt? We heard earlier about Shropshire, Herefordshire and Stockport, where three, two and two schools respectively will not be rebuilt.
	The Conservatives cannot take that much money out without cost. I have to tell the hon. Member for Bognor Regis and Littlehampton (Mr. Gibb) that they cannot create 220,000 new places without using them to replace underperforming schools and without incurring a cost. In my constituency, and in many others that are later in the BSF programme, we shall keep asking the Opposition the same question: who misses out? Which parents and children will lose out to pay for the excess places?
	Academies have been a transformational reform. In the areas that need it most, for the children who need it most, they have replaced schools that have let communities down. Their results are improving faster than those of any other type of school, as we heard from the hon. Member for Bognor Regis and Littlehampton. That is why we announced new academies and new sponsors today. That is why we have opened 83 academies, with more than 300 more to come.
	Academies are a means to an end. They stand alongside our other reforms, which include the new discipline powers created following the Steer report, the consistent roll-out of synthetic phonics introduced following the Rose review, one-to-one tuition in the basics, extended schools with catch-up and stretch classes, and a new flexible and engaging secondary curriculum that will start in September. New qualification choices will be introduced for 14 to 19-year-olds, such as the diplomas that will combine academic and vocational learning in a new style of teaching. That approach was opposed by the Conservative party.
	Our reforms also include raising the age to which people must carry on in some form of education. That was also opposed by the Conservative party. New providers from the public, private and voluntary sectors are running and partnering schools. We have parent schools, academies, trusts, faith schools and, of course, community schools. We have the vision to match today's and tomorrow's challenges, while the Conservative party is limited to coming up with headlines for the papers.
	The hon. Member for Surrey Heath began with a quotation from St. Francis of Assisi—the same quotation that Mrs. Thatcher used on the steps of Downing street. My hon. Friend the Member for Livingston (Mr. Devine) tells me that when Mrs. Thatcher was uttering those immortal words he was organising a strike at  The Press and Journal. Perhaps that demonstrates the beginnings of some interesting judgment.

Andrew Lansley: I beg to move,
	That this House supports NHS staff in their efforts to minimise healthcare associated infections; notes with distress the failings disclosed in the report by the Healthcare Commission into the outbreaks of clostridium difficile at Maidstone and Tunbridge Wells NHS Trust; deplores the failure by the Department of Health to secure new leadership at the Maidstone and Tunbridge Wells NHS Trust at an earlier stage; regrets the repeated failure of the Government to ensure compliance with proven methods of containing infections, including screening prior to admission, adequate isolation facilities and optimum bed occupancy rates; and calls on the Government to support NHS bodies in implementing zero tolerance strategies for healthcare-associated infections.
	Time and again, we have brought Ministers to the Chamber to try to get action to combat infections in hospitals. Time and again, they stand at the Dispatch Box and say that that is a priority. Time and again, the independent evidence shows their subsequent failure to do what is proven to be needed. The Healthcare Commission's report on the outbreaks at Maidstone and Tunbridge Wells NHS Trust is only the latest, although possibly the worst, example of such reports.
	When we brought the Secretary of State to the House, he said that that was an exception, but in 2005, the latest year for which we have figures, 3,807 deaths were reported to be associated with Clostridium difficile, and 1,629 with MRSA. In 2006 some 20 NHS Trusts had C. diff rates higher than those reported at the Maidstone and Tunbridge Wells NHS Trust, although I hope that very few of those trusts are responsible for the kind of failings that were disclosed at Maidstone.
	The purpose of the debate is once again to demand that the Government implement the comprehensive strategies against hospital-acquired infections that they have been advised to pursue for years. In particular, we hold the Secretary of State to account for his failure to act in relation to the failings at Maidstone and Tunbridge Wells. In our motion I have focused on three main topics—screening, isolation facilities and bed occupancy rates. I acknowledge that there is much else that will form part of a comprehensive strategy, including an antibiotic regime, high cleaning standards, improved hand hygiene, surveillance and new technologies for antimicrobial techniques and surfaces. I set out much of that in our previous debate in January, but I draw attention to the three matters that I mentioned, over which the Government could exercise influence through investment and policy.
	In the chief medical officer's report "Winning Ways", published in December 2003, he stated:
	"Some countries have been particularly successful in controlling MRSA.. Notable is the experience of the Netherlands. The Dutch strategy has been based on a policy of 'search and destroy'. This involves screening patients for MRSA and isolating those found to be positive. . .The Dutch have been able to set aside sufficient numbers of single rooms in modern hospitals and maintain a high healthcare worker to patient ratio. As a result, this approach has been remarkably successful."
	So for nearly four years—I am sure hon. Members sometimes get tired of hearing us go on about it—based on that evidence, we have been calling for a search and destroy strategy.
	If the Government had listened to the chief medical officer in the first place, and latterly to us, we would be halfway through the process of removing endemic infections, particularly MRSA, in our hospitals, and we would be halfway to achieving some of the MRSA rates experienced in the Netherlands and Denmark, and, as the European antimicrobial resistance surveillance survey published Europe-wide this week suggests, we would have made greater progress in the same direction as France has done. Thus far, however, we have not matched its performance.

Andrew Lansley: I am grateful to the hon. Lady. I recall her Adjournment debate on that subject earlier this year, which clearly caught the interest of the House. Where C. difficile is concerned, staff in the NHS need to be extraordinarily well aware of the risks that they run with broad spectrum antibiotics, particularly when they are combined with proton pump inhibitors, because the combination of those two things can leave patients very vulnerable to the consequences of C. difficile infection and its proliferation. The hon. Lady refers to one way of combating that, but another would be the use of probiotics, which has been pioneered in Nottingham.
	The hon. Member for Bolton, South-East (Dr. Iddon) talked about things being obvious. Some of the things on which we should focus have been obvious for a long time—the point is that those things have not been done. Let us take the screening of patients for admission. Ministers have repeatedly told the House that they are in favour of screening at-risk patients, but it was not until September this year that they came to the House to say that they supported the universal screening of admissions. I welcome the fact that they have now done that, albeit that it is nearly three and a half years since we called for it to happen.
	This is not the first time that the Department of Health has advised that. Last November a best practice code was published, which said:
	"The logical conclusion of risk factor assessments and the results of modelling studies is that the most appropriate approach to the reduction in MRSA carriage in the population, and resultant MRSA infection, is the universal screening of all admissions to hospital".
	Now, a year later, Ministers tell us that they are going to put in place the resources to support screening; we said during the general election that that should be done and that the necessary technology should be supported.
	The hon. Member for Bolton, South-East mentioned research; we said that there should be research and support for new technologies to deliver rapid screening, so that when one is in a ward and asks staff about the process of managing patients, one does not find that it will be two days before they are in a position to be able to access results and know whether patients are infected.
	In the past few weeks, I have had responses to freedom of information requests that I made of hospital trusts, and the results are deeply disappointing. Only 2 per cent. of trusts said that they screen all patients for MRSA, only 32 per cent. of trusts can provide any data on the number of patients screened, and not one trust collects data on whether patients are isolated following a positive MRSA screening result. None offered data on whether, if a patient was screened and found to be positive, they would as a matter of course be put in a single room or isolated. I am afraid that that rather accords with the findings of the Health Protection Agency, which were published by the Department just a couple of weeks ago, although not with a press release. The HPA said that nearly one third of trusts did not screen all patients, only 60 per cent. screened all previously MRSA-positive patients, and only 55 per cent. screened all patients from nursing homes, despite that being a high-risk factor. It is all very well to say that there should be screening of admissions, including emergency admissions, but that has been said before and it has not been done. We want to see results.
	On the isolation of patients, Pat Troop, chief executive of the Health Protection Agency, said:
	"The most effective way of controlling the spread of both Staph. Aureas and MRSA is through early detection and appropriate isolation and treatment."
	In 2004, the National Audit Office noted that many trusts had undertaken a risk assessment but only a quarter had obtained the required isolation facilities. The study published by the Department last month said:
	"Three quarters of Trusts indicated that they had problems implementing isolation policies due to inadequacies in the number and fitness for purpose of isolation rooms."
	What about bed occupancy? In April 2001, the Government said, in response to the Public Accounts Committee:
	"Health Authorities should plan bed numbers in order to achieve a bed occupancy rate of no more than 82 per cent. in 2003-04."
	What happened after that? The bed occupancy rate went up. It is still at 84.5 per cent., and in many parts of hospitals, it is way above that.

Andrew Lansley: That is extremely important. The code of practice, which we debated in the House a year ago, and which Ministers said would solve those problems, specifies in terms that there must be openness and information to the public about infection rates. It is quite astonishing that in a press release the management of the Maidstone and Tunbridge Wells NHS Trust tried claim that infections had been brought in from the community. Only a small proportion of infections were acquired that way, so it was an outrageous claim.
	Astonishingly, senior managers—the director of nursing and the chief executive—at one point denied to the Healthcare Commission that it was the trust's policy not to cohort patients for nursing. Contrary to the guidelines, that was exactly what was being done, but they did not seem to realise that, so management failings were extraordinary.
	In the light of its findings earlier this year, the Healthcare Commission knew that there were significant failings in the management of the trust—but it was not until the publication of the report that the chairman and the chief executive resigned. More recently, non-executive directors and the former director of nursing have resigned. No one who saw the commission's report when it was presented to the Department of Health in May could have come to any conclusion other than that the failings in the trust's management and leadership were so great that they needed to be replaced.
	The Secretary of State says that he was not asked to replace the management by the Healthcare Commission, so he did not do so. He hides behind the commission. He has instituted an independent leadership review, even though it will not serve any purpose, because the leadership has failed and its members are disappearing. One of them took a large severance payment, which the Secretary of State claims that he can stop—I doubt that he can—and the leadership is not in place in Maidstone and Tunbridge Wells to follow up the report and demonstrate to the public's satisfaction that there is new leadership in place. It will take far too long for that leadership to be put in place, but it should have been put in place in May, when the findings were first presented to the Department.

Andrew Lansley: My hon. Friend makes an important point. If the Secretary of State had taken the action clearly indicated in the report and used his powers under section 66 to remove or suspend the board and put new leadership in place, my hon. Friend and his constituents would know that that leadership would be permanent and would take the necessary action. However, the Secretary of State did not do that. He hides behind the Healthcare Commission, but that is not its responsibility. It should investigate problems and report on them. It is the responsibility of the strategic health authority in the first instance, the NHS chief executive in the second instance, and Ministers in the third instance to exercise the power of performance management and, if necessary, to intervene. They have the powers under NHS legislation, but they did not use it.
	The Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw) is always telling me that a consequence of our policy would be a lack of accountability to Parliament. Ninety patients died— [ Interruption. ] Indeed, since September 2006, there have been further deaths associated with C. difficile at the Maidstone and Tunbridge Wells NHS Trust this year. Who has come to the House to be held accountable for that? If Ministers are genuinely accountable, they should have used the powers that they claim are so important and done something about the problem. If they are not prepared to use them in those circumstances, in what circumstances would they use them?
	Part of the report entitled "Developments since the investigation was announced" describes "musical chairs" among senior executives. There were further outbreaks of C. difficile in January in the Kent and Sussex hospital; in April at Maidstone and Tunbridge Wells; and in May and June there were 45 new cases of C. difficile at Maidstone, and nine deaths. I am not arguing that the failings disclosed up to September 2006 have continued to anything like the same extent, but it is perfectly clear from the report that things that should have been done have not been done. The policies were not shown on the departmental intranet. Earlier this year, the Healthcare Commission said that it was still observing patients with diarrhoea on open wards, and it saw patients with MRSA being barrier-nursed on such wards.
	What was done to ensure that the new management at the Maidstone and Tunbridge Wells NHS Trust was in place at the right time? The Secretary of State did not take the action that he should have taken. He should be accountable to the House for that simple fact.

Andrew Lansley: I recall the occasion that my hon. Friend mentions, and also his Adjournment debate on the subject. The Government said nothing about C. difficile and, when we challenged them about what they would do, it was obvious that they had targeted MRSA and that C. difficile rates had risen because of lack of action on, for example, hand washing. They said that they did not believe that it was right to have a national target; a central target was wrong. They claimed that the targets had to be local because there was such local variation in C. difficile. Ten months later, the Secretary of State came to the House to say that central targets were essential. The Government have no comprehensive strategy and cannot even manage, in the space of a year, to maintain a consistent policy. The Conservative party has a strategy and a policy, which we would be prepared to pursue.
	The amendment states that
	"healthcare-associated infections (HCAIs) are a worldwide problem".
	Indeed, they are. However, a Europe-wide survey shows that places such as Denmark and the Netherlands have succeeded with MRSA where we have failed. Even the French and the Slovenians have moved substantially in the right direction, whereas, according to the European Antimicrobial Resistance Surveillance Survey, we are moving in the wrong direction.
	The Government had a policy of "bare below the elbows". That is good, but their document states that
	"it seems unlikely that uniforms are a significant source of cross-infection."
	They have a "deep clean" policy, but a press release that the Department published in September claimed that trusts were, in any case, conducting a deep clean on a ward-by-ward basis. Although the Prime Minister announced the policy, we found that no follow-up or evaluation was intended, and that it is only now that the Department is trying to put in place some structure for deep cleaning.
	Yet in 2000 the NHS plan pledged
	"a nation-wide clean-up campaign throughout the NHS starting immediately".
	The right hon. Member for Darlington (Mr. Milburn) said in 2001:
	"This extra money will help get the basics right. It will drive forward the biggest clean-up campaign there has ever been in NHS hospitals."
	The right hon. Member for Airdrie and Shotts (John Reid) said in 2004, when he was Secretary of State:
	No stone is being left unturned in the battle against the superbug. We are improving cleaning standards, rolling out cleanyourhands and making sure infection control is a fully staffed priority for every NHS trust".
	He said that approximately two months before the outbreak at Maidstone and Tunbridge Wells began, in circumstances in which nursing staff were not capable of delivering that priority.
	We are told that there are to be 3,000 extra matrons. What is the evidence base for that decision? How long was it in gestation? Where is the consultation document for the Royal College of Nursing to consider its appropriateness? Why a matron for every two wards—why not a matron for every three or four wards? Where did that policy originate? Is it a case of what  The Lancet described as
	"Politicians...pandering to populism about hospital cleanliness"
	and not listening to the evidence?
	The Government claim that they want targets, but 45 per cent. of trusts said that they had difficulty reconciling the targets for accident and emergency attendance with those for hospital-acquired infection. The amendment is too little, too late. The Government say that targets are essential, yet they get in the way of NHS staff doing what they need to do. We need a strategic approach, the resources to help NHS staff achieve the goal and time for change. I commend the motion to the House.

Alan Johnson: The important change is that the PEAT scores were based then on one visit and the hospital was usually aware that the visit was going to be made. From this year, however, there will be a year-round appraisal that will not be based on the position at one day in the year. Standards have to be maintained through the year, but I accept that this is not the only issue. I am setting out a whole series of measures that we are introducing to tackle the problem.
	The House will be aware that we have also introduced a strong statutory regime to support our drive to tackle infections. The Health Act 2006 introduced a mandatory code of practice for the prevention and control of health care-associated infections. That came into force on 1 October 2006 and it requires NHS bodies to have management and clinical governance systems in place to deliver effective infection control. Compliance with the code is assessed by the Healthcare Commission, which is in the course of making 120 unannounced visits, mainly to acute trusts, to ensure compliance. We have also announced that from next year, health care-associated infection inspections by the Healthcare Commission will be undertaken annually by specialist teams.
	We will continue to support the NHS to bring down infection rates. There is no single solution. In the past few months, we have introduced further measures to build on improvements already made. In July, we made an additional £50 million available to directors of nursing and a further £270 million will be made available by 2010-11 to support the drive to tackle infections. We are introducing MRSA screening for all patients—starting with elective patients—supported by £130 million of comprehensive spending review investment. We have published new guidance on uniforms, so that all staff workwear leaves the arm bare below the elbow to assist with hand washing, which is crucial in countering such infections.
	To improve cleanliness and ensure that patients have confidence that their hospitals are safe, we have announced a deep clean of all hospitals, supported by strategic health authority funding of £57 million. This morning, I placed in the Library details of this funding for each area of the country.

Norman Lamb: I accept that. None the less, we must take the report very seriously, and I have quoted directly from it. Although the Secretary of State talks, rightly, about avoiding top-down targets, but they have often led to over-full hospitals. The report mentions the pressure of targets. The Secretary of State shakes his head, but page 8 of it says:
	"The trust struggled with a number of objectives which they regarded as imperative. These occupied senior managers' time and compromised control of infection, and hence the safety of patients."
	Page 9 says:
	"We are concerned that where trusts are struggling with a number of problems that consume senior managers' time, and are under severe pressure to meet targets relating to finance and access, concern for infection control may be undermined."
	There is specific reference to A and E targets:
	"One senior manager said that because of other pressures and 'over-heating' in the trust, the A&E target was delivered at the price of chaos elsewhere in the system."
	The Secretary of State has to understand that Maidstone is not alone; those concerns apply across the NHS. Trusts often feel that they are bamboozled by targets. He has accepted in other contexts that an over-reliance on top-down targets sometimes has perverse effects. I am in a sense challenging him to concede that that is a factor in the problem, as the Healthcare Commission recognises. Does he accept what the commission says? If so, is he prepared to ensure that hospitals are given guidance stating that, although there are other priorities, this must be the top priority?
	The third issue that the Healthcare Commission deals with is the pressure of finances, which is a Government responsibility and leads, among other things, to cuts in nursing staff. The report says:
	"Both trusts had undergone difficult mergers, were preoccupied with finances, and had a demanding agenda of reconfiguration and private finance initiative... Additionally, the impact of financial pressures was to reduce further already low numbers of nurses and to put a cap on the use of nurses from agencies and nursing banks."
	Does the Secretary of State accept that in the past two years intense financial pressures on trusts to balance their books have sometimes had perverse consequences? That appears to have been the case at the trusts in question.
	The next issue in the report raises is the MRSA target. What concerns me is that, by targeting only reductions in MRSA, the former Secretary of State imposed what I regard as a political target of halving the MRSA rate by 2008, without paying any attention to C. difficile, which was increasing very rapidly. Again, the Healthcare Commission raises concern about that issue. Page 7 of its report says:
	"Before the outbreak it only monitored the MRSA rate, as there was a national performance target in relation to MRSA, though not as regards  C. difficile."
	So the trust's attention was focused on MRSA, not on the bigger problem of C. difficile.
	The strategic health authority has a role as well, as the report says that, before August 2006,
	"the SHA was not aware of the relevant performance of trusts with regard to rates of  C. difficile infection."
	That body is supposed to monitor the performance of trusts in its area.
	Commenting on the role of the Health Protection Agency, the report says that meetings with directors of infection prevention and control in Kent "focused on MRSA" and that there
	"was no local monitoring of C. difficile".
	Again, the focus was on what the Government chose to target—I think for political reasons—rather than on the growing problem of C. difficile. Again, targets distorted clinical priorities. Does the Secretary of State accept that setting arbitrary targets for MRSA, at a time when other hospital-acquired infections were increasing, had perverse consequences and was dangerous and damaging?
	The next issue is antibiotic prescribing. All the professionals I have talked to say that that is the central and most important issue when dealing with C. difficile. I was surprised that the motion makes no reference to antibiotic prescribing.  [ Interruption. ] I know that the Conservative spokesman talked about it. The Government amendment also misses it out. The Healthcare Commission report says:
	"Antibiotics need to be seen, like all medication, as potentially dangerous drugs".
	In 2005, a study of 300 European hospitals showed that the highest levels of MRSA were associated with hospitals using a high level of antibiotics, particularly the broad spectrum antibiotics that we have debated previously. The Health Protection Agency and Healthcare Commission report in 2006 said that 38 per cent. of trusts did not have restrictions in place to prevent inappropriate antibiotic use.
	The Government have issued new guidance on antibiotic use, but is it being monitored? Have trusts implemented the new guidance, and is it being applied effectively? It is clearly important that the prescriptive rules are applied. When I visited Hereford county hospital last week, I was told that a new policy on antibiotics had been introduced earlier this year and had had a dramatic effect.
	Beyond Maidstone, the Conservative spokesman referred to the importance of screening and he was right to question why it has taken so long to introduce it. The Government say that they will introduce it for non-emergency cases by next year and for emergency cases within the next three years. In Hereford, I was told that screening of emergency cases had been implemented earlier this year. If that hospital and a small percentage of others—the Conservative spokesman referred to a survey he had undertaken—can do it, why cannot all hospitals? Does it really need to take three years to implement screening for emergency cases across the country?
	I will conclude by setting out what we see as the priorities. First, I urge the Government to undertake a thorough, robust review of the impact of overcrowding in our hospitals. Overcrowding does not necessarily mean that a certain scenario will happen, but all the evidence indicates that there is a link, which needs to be addressed. The trends are in the wrong direction.
	Secondly, there needs to be zero tolerance of failures of infection control. We need to get the mindset right. If senior hospital managers have failed in their duties to control infection, that needs to be treated as gross misconduct—it is that serious—rather than their getting a pay-off and a comfortable early retirement. That principle needs to apply throughout the trust, from the most senior people to those working on the wards. There should be no pay-offs. I acknowledge that the Secretary of State indicated that himself.
	The next point is that matrons must be in charge of the staff in the ward, even if those staff happen to be employed by an independent contractor. The matron needs to have the power to remove an individual from the ward if they are not meeting the required standard.
	There has been discussion about the Dutch approach. I recognise that rates in the Netherlands are not much lower, but we ought to acknowledge its good practice and strict process to deal with outbreaks. The Secretary of State is right that that is possible only because of the space in Dutch hospitals, but that brings us back to the occupancy rate. There needs to be space for isolation, and to enable a hospital to have some slack in the system. He is right that historical underfunding in this country resulted in too much pressure on the system, but staff need to be sent home if they are infected.
	There need to be changing facilities for staff. Again, the Secretary of State is right: it may not be appropriate to impose such measures from above, but surely the Department of Health needs to say that all hospitals should, as a matter of best practice, have changing facilities for staff, so that they do not have to travel home on a bus in their uniform. We need monitoring of death certificates to ensure that it is common practice to record hospital-acquired infections when they are a contributory factor to death. The Healthcare Commission report found, in the sample from Maidstone that it considered, that in 20 per cent. of cases where C. difficile was not mentioned on the death certificate, it was a contributory factor. In other words, if we simply looked at death certificates, we would understate the scale of the problem. In many cases—I have come across the issue as a constituency MP—people who have died in hospital had C. difficile but there was no reference to it on the death certificate. We need common good practice on the issue, so that we can accurately assess the scale of the problem. The rules on antibiotic prescribing should be rigorously applied, too.
	Finally, it is important to give the patient the power and the right to raise concerns in hospital about failures in hygiene standards. There must be a mechanism through which the patient feels able to raise concerns in hospital without feeling that they will suffer in some way. I recognise that the Government have taken steps to address the issue of hospital-acquired infections, but the question is whether they are doing enough, and are doing the right things. Today, I have raised a series of issues that the Healthcare Commission highlighted, and that fall within the Government's responsibility. If the Government intend to criticise the trust—and it is right that they should—they must also acknowledge their role and what they can do to address the concerns that the commission raises. I think that we all agree that the issue has to be treated as a top priority, so that we can ensure that people are safe when they visit hospitals, care homes and nursing homes.

Shona McIsaac: I come to this debate as someone who has actually cleaned hospitals in a previous job. I have cleaned up after patients who have been suffering from the conditions in question, and it is tough to do so, particularly when dealing with something like Clostridium difficile, and the sheer number of spores that are produced in the faeces of someone with diarrhoea as a result of C. difficile. They are produced in enormous numbers, and it is quite tough to clean all the surfaces involved to ensure that there is no transmission from the environment. I did that work many years ago, so the situation is not new. C. difficile has been with us for many decades, and it is only recently that there have been particular problems, which I shall come to later.
	I want to start by talking about methicillin-resistant Staphylococcus aureus. I have listened to debates on this issue so many times in this House. I listened to what the hon. Member for South Cambridgeshire (Mr. Lansley) said, and I believe that he oversimplifies a complicated subject. He makes comparisons with other countries, such as the Netherlands, but when we are dealing with MRSA, we are dealing with something like 17 different strains. The strains prevalent in hospitals in places such as the Netherlands are different from those prevalent in this country.

Shona McIsaac: The hon. Gentleman has missed the point that I am making. This issue is far more complicated than is often evident in short debates such as this, as we tend to make simplified speeches. Of course we should take note of what happened in the Netherlands, but if we simply transferred everything that was done in that country to the UK, it would not have the same effect, because we are dealing with different strains of MRSA.
	Some 30 per cent. of us carry Staphylococcus aureus on our body: one third of the Members who will go into the Division Lobbies tonight carry it on their bodies. Some of us even carry resistant strains, but the majority of us are healthy individuals. Staphylococcus aureus acts opportunistically, and targets people with compromised immune systems who are vulnerable to it. Most of us will not be troubled by MRSA.
	We have to consider why Staphylococcus aureus has become a problem in this country. It is largely to do with the inappropriate prescribing of antibiotics in past decades. People were often given antibiotics almost like sweeties: if someone had a snuffle or a cold, they would be given antibiotics. It was quite wrong to give people antibiotics in those circumstances, as they killed off many of the less damaging strains of Staphylococcus aureus, so that the resistant strains came to the fore and became increasingly prevalent. We must therefore look at prescribing regimes, and hold back from prescribing so many antibiotics. That is as true for C. difficile as it is MRSA.
	The Northern Lincolnshire and Goole Hospitals NHS Foundation Trust is my local NHS trust. It is responsible for three hospitals, and it pioneered the cleanyourhands initiative. MRSA rates have continued to decline, and the trust's target is one case a month across all three hospitals. The trust has one of the lowest MRSA rates in the country, because it pioneered that initiative, but—and this is a gripe I have with the Government—it was told to reduce that rate by half. Given that it already has one of the lowest rates, the statistics become quirky. If we have two cases a month, one of which might be acquired in the community, not hospital, we will not reach our target. People will report the trust as a failing regime, but in fact the chances of acquiring MRSA in those hospitals is minimal.
	I pay tribute to the phenomenal work undertaken by those hospitals to bring the rates down. For example, they assume that everyone who is admitted is MRSA-positive unless proven otherwise. Everyone has to undergo an alcohol body wash to decolonise the body of MRSA, and the hospitals will soon progress to nasal decolonisation as well. The cleaning in those hospitals is in-house, and that is welcome. They are considering more innovative ways in which to deal with cleaning to reduce not so much MRSA but other infections.
	Let me consider C. difficile. Again, I pay tribute to Diana, Princess of Wales hospital, Goole hospital and Scunthorpe district general hospital. They are working hard on C. difficile and putting in place cleaning regimes to tackle the environmental contamination that can occur from the multitude of resistant spores that C. difficile produces. Their work is phenomenal.
	The right hon. Member for Maidstone and The Weald (Miss Widdecombe) is present, and I emphasise the fact that I do not believe, considering the science behind the subject, that we will ever completely eradicate C. difficile. There are 100 types—I think type 027 causes the problems that we are experiencing in the UK. It produces many toxins, which lead to fatalities. It is so resistant and produces so many spores that I am not sure whether we shall completely eradicate it. However, the work being done to reduce it is welcome. Again, we must stop prescribing so many strong broad-spectrum antibiotics, which destroy the good bacteria in the intestine, thus allowing the production of the toxins. That is a serious problem.
	I pay tribute to the work in my area to reduce the rates of C. difficile and MRSA—I will not go into detail about pseudomonas or norovirus this afternoon. However, I should like the Government to consider the statistical quirks, which show that one case per month across three hospitals is fine, but two cases mean the red zone. We must reconsider that. It was disheartening for staff to be told that they were in the red zone because there were two cases, as opposed to one, across three hospitals.

Oliver Heald: My hon. Friend's description rings a bell? It is an example of systematic incompetence, which is a factor that we see across government.

Anne Milton: Of all the reports that hon. Members may have read recently, none is more damning or more distressing to read than the Healthcare Commission's report into the outbreaks of C. difficile at Maidstone and Tunbridge Wells NHS Trust. I have no doubt that the sense of betrayal among local people is immense. The success of the NHS is largely down to the confidence and trust that people have in the organisation and its staff. There is no doubt that the majority of NHS staff continue to work to achieve exactly that end. The rise in health care-acquired infections has seen the loss of that trust, a loss of confidence and an increasing sense that NHS staff are no longer in control of their own decision making.
	We have heard some excellent speeches. I did not entirely follow the speech made by the hon. Member for Livingston (Mr. Devine), but I am concerned that his attempt to focus on the events of 20 years ago or more was simply an opportunity to deflect attention from the failures of the Government today.
	As a former nurse, I thank my hon. Friend the Member for Ilford, North (Mr. Scott) for his tribute to nurses across the country. He gave a particularly evocative account of two of his constituents, one of whom sadly died. He also raised the issue of large payouts to senior managers, which continues to concern a number of hon. Members, particularly when those managers have presided over significant failures in trusts. He was generous, however, in his praise of the Secretary of State.
	The hon. Member for Vale of Glamorgan (John Smith) was also generous in his political stance and raised the important issue of venous thromboembolism. The hon. Member for Wellingborough (Mr. Bone) mentioned his concern for his constituents, who are served by a hospital with the worse C. difficile rates in the country. As well as paying tribute to all NHS staff, he also mentioned the experiences of one of his constituents.
	My right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) talked about authority and accountability on the ward through the ward sister. I am sure that I speak for all hon. Members when I say that her anecdote about a nurse who went to use a syringe that had fallen on the floor was truly shocking. She also mentioned the confused role of senior nurses, nurses covering shortages and form-filling. She spoke with her usual and much-welcomed common sense.
	The hon. Member for Cleethorpes (Shona McIsaac) spoke passionately about the prescription of broad spectrum antibiotics. She paid tribute to her local trust, which I gather is a centre of excellence. She also mentioned the fact that figures can be extremely misleading.
	My hon. Friend the Member for Tunbridge Wells (Greg Clark), like my right hon. Friend the Member for Maidstone and The Weald, was particularly touched by the recent events, which left 90 people dead, while 270 deaths had C. difficile cited as a contributory factor. My hon. Friend has campaigned long and hard for a new hospital and has been particularly concerned about the issues associated with built structures, nurses and their uniforms and the practices that are followed. No one knows better than him the urgency with which the matter needs to be dealt.
	My hon. Friend the Member for Tiverton and Honiton (Angela Browning) mentioned leg ulcers. Labour Members mentioned research and the overuse of antibiotics. In particular, the hon. Member for Bridgend (Mrs. Moon) mentioned treatment with maggots. My hon. Friend the Member for Westbury (Dr. Murrison) talked about the need for the Government to face up to the situation and cited individual constituents' experiences.
	My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) spoke from the Front Bench and focused in particular on screening, isolation and bed occupancy. He also referred to the Government's plans for a deep clean. In particular, he noted that the Department of Health had said that there was no central programme for that, nor any plans to monitor progress, and that it was a matter for local determination. In addition, the Department said that no dates had been set for commencement or completion of the deep clean, that there would be no new money for it nor any repeat programme. Finally, my hon. Friend noted that the Department had supplied no news on training—perhaps the Minister will be able to bring us up to date about exactly what training will be given to help NHS staff to achieve this so-called deep clean. It seems to me, and I am sure to many Opposition Members, to be no more than a gimmick.
	A Healthcare Commission report was published in July in response to requests from the chief medical officer for ways to reduce infection rates. It stated:
	"We found evidence that a significant number of trusts were also experiencing difficulties in reconciling the management of"
	health care-acquired infections
	"and cleanliness with the fulfilment of targets".
	It would be awfully welcome if the Secretary of State listened to this bit, as it is the one that I do not think that he entirely understands. He needs to grasp the difference between targets and outcomes. He does not support outcome-driven activity, but he does support process-driven targets. For exactly the reasons cited in the Healthcare Commission report to which I have referred, he needs to pay attention because, if he continues with his obsession with targets, we will not see any improvements.
	The report found that 45 per cent. of trusts were experiencing difficulties with accident and emergency targets. In addition, 29 per cent. of trusts told the commission about difficulties with waiting times and lists for the treatment of in-patients, while 36 per cent. reported that they had experienced difficulties reconciling the management of health care-acquired infections and cleanliness with the fulfilment of financial targets. The Secretary of State continues to deny that evidence.
	Moreover, the report found that 46 per cent. of trusts do not have a programme to check the cleaning of beds and the spaces around them. Only 48 per cent. of trusts report all health care-acquired infections, and 19 per cent. report none. Another 26 per cent. report less than half of such infections, and 62 per cent. do not audit readmission to hospital of people suffering from them. The report is truly damning about what is going on.
	Until the Secretary of State starts to listen, and to accept the causes and consequences of health care-acquired infections, rates will continue to rise. Protesting about the progress that has been made while denying the figures and causes will not get anywhere. The right hon. Gentleman asked that this debate be non-party political, but he must accept the facts. The problems are to do with bed-occupancy rates, targets, competing priorities, antibiotic prescribing habits, the number of nurses on wards and the number of hand basins available per bed. They are also to do with our built structure, and with training, monitoring, audit and the need to change practices on the basis of that audit.
	The Secretary of State maintains that infection rates here are similar to those in the rest of Europe, but I doubt that that is any comfort to the relatives of the 90 patients who died in west Kent. We must adopt a ward-to-board approach, but hospital boards must be able to make decisions on the basis of clinical need, not of Government targets. That means that some targets must be let slip sometimes, but a culture in which senior managers do not listen to what is happening at ward level because they fear not meeting Government targets and thus getting sacked will mean that what happened at the Maidstone and Tunbridge Wells NHS Trust will occur again.
	I urge the Government to look again at the debate. I urge them to rise to the challenge that health care-acquired infections raise. I urge them to return to decisions made on clinical grounds by clinical staff in clinical settings. I urge hon. Members to support the motion.

Ann Keen: I thank my hon. Friend for that comment. It is the duty of us all to look at every innovation and change in technology and science to help with this important health care issue. Hon. Members on both sides of the House have mentioned research, and we could consider it in an all-party way, because of the victims and their relatives and given the seriousness of not doing so. I make a plea to look at all the experience together to try to bring about a safer health care environment for all our constituents. To do that, much of Lord Darzi's review of the NHS is addressing one of the main issues—quality and safety—and I look forward to the consultation, to which Members who have spoken today will contribute.
	My hon. Friend the Member for Vale of Glamorgan (John Smith) is a champion of tackling the DVT that he recognises with his group, and patient safety is paramount to him.
	I accept the invitation to visit, made by the hon. Member for Wellingborough (Mr. Bone), and it is very important that I do so. I have visited many constituencies to date and seen the improvement. In particular, I was able to see the change that has been made at the Countess of Chester hospital, when my hon. Friend the Member for City of Chester (Christine Russell) invited me to Chester—an area that I hold dear to my heart, because I started my NHS work as a clerk at Chester infirmary.
	The hon. Member for Tunbridge Wells (Greg Clark) mentioned that money should be made available for changes in design and, very importantly, for patient safety. I remain concerned that money is being mentioned, because the money is available for such things to take place, and I am happy to investigate that further.
	In relation to the uniform guidance—an issue that was raised by the Opposition Front-Bench spokesman—it is recognised good practice for staff to change at work before going home. There is no evidence of a risk of infection, but there is evidence of an effect on patient confidence, which is of course important.
	We must remember that the latest figures from the Health Protection Agency show that we are heading in the right direction in tackling infection. I am looking forward to seeing how best we can demonstrate the effects in further reducing health care-associated infections. The further investment highlighted by the Secretary of State in his opening speech will cover further measures such as screening for MRSA for elective patients. It will also ensure that every acute trust has undergone a deep clean by 31 March next year. I hope that Members on the Opposition Front Bench will note that that is not a gimmick; it is a reality. It will happen by 31 March next year.
	The private sector, in the main, undertakes elective surgery, which is very different from the work that our NHS does. The Health and Social Care Bill, introduced last week, will establish a new regulator. I urge hon. Members to vote to support the new tough powers that will allow that regulator to investigate and intervene on issues such as health care-associated infection.
	The issues of targets and bed occupancy have been raised. Patients have a right to clean and safe treatment, regardless of where in the NHS they are treated. I am very clear that if trusts fail to deliver that, senior managers and trust boards will be held accountable. As has been said, that will go right down the line from the ward to the board. There are no excuses. The management of complex systems, such as health organisations, requires the balancing of many different priorities.

David Simpson: I am very glad to have succeeded in obtaining this Adjournment debate.
	Northern Ireland has made some progress in recent times, and we can see advantages of devolution in proper scrutiny, accountability and local decision making. Instead of killing the police, mainstream republicans have signed up to public support for the Police Service of Northern Ireland. Those are steps forward towards a final destination, but other issues still need to be tackled. We need a new beginning to parading. Victims and survivors of the troubles must be kept to the fore, not just in funding but on a settled, strategic basis. Equality issues cry out for reform. In time, we must move on to a more normal system of government, and it is vital that the IRA's so-called army council be stood down.
	There are also serious issues surrounding the activities of dissident republican paramilitary organisations. Northern Ireland recently witnessed a stark and brutal reminder of our darker past. I know that I speak for all hon. Members when I condemn such attacks without hesitation. We all wish the police officers a speedy recovery, and wish, too, for speedy arrests, trials and convictions. That process would be greatly aided if, alongside words of condemnation, senior republicans, out of a sense of civic duty, passed on everything they knew about such people to the PSNI.
	We must also tackle the continuing problem of loyalist paramilitary organisations. Yes, the recent announcement was a step that takes things a bit further along. However, more remains to be done to deal with weapons and to call time on all forms of criminal activity. We are debating policing this evening, and everything that ties up necessary police resources contributes to making society less safe and people less secure. That goes for loyalist as well as republican communities.
	The current position of mainstream republicans also requires attention. The recent murder of Paul Quinn brought that to the fore once again. If it emerges that the IRA sanctioned that cowardly murder, will the Government take the view, as they did in the past, that democrats should be punished with the guilty, and say that we must continue to sit alongside them in an Executive? Would the Government then seriously propose devolving policing powers in such a setting? Have the Government genuinely learned so little? Is that what they expect—or perhaps what they expect of Northern Ireland politicians? Is that what they would call on the people of Northern Ireland to accept? If the Government are serious about devolution in Northern Ireland and about ever devolving policing and justice powers to Northern Ireland, they will display that seriousness now, or else they will show that they have not learned the lessons of recent years.
	We must also consider how we can best assist the police in performing their duties. Northern Ireland needs a police college, and work needs to commence urgently. The Northern Ireland Office has been stalling over police community support officers. When will proper funding be forthcoming? That needs to be tackled, and I urge the Minister to inform us exactly when the necessary steps will be taken and confirm that recruitment of police community support officers will definitely commence in April 2008.
	We must also consider the way in which we deal with past crimes. There is a continuing denial by many of their past. That is especially true of the republican movement. There is huge denial by republicans about what they call collusion. On 30 July, Gerry Adams said:
	"Collusion and the use of counter-gangs were an integral part of British policy."
	Speaking at the so-called march for truth in Belfast, he stated:
	"We are determined to campaign even though it may take a long time, until the British state acknowledges its administrative and institutional use of state violence and collusion...everyone knows that these tactics were employed by the British...but the British government has never acknowledged it... The extent of this cover-up is breathtaking."
	He continued:
	"Yes the British recruited, blackmailed, tricked, intimidated and bribed individual republicans into working for them and I think it would be only right to have this dimension of British strategy investigated also. If the British state used former republicans to do its killing for it then the victims of that policy have the right to truth also."
	Mr. Adams is in the state of denial that has come to characterise Irish republicanism.
	I now come to a more personal part of my speech, which is about a relative. On 1 May 1979, ex-Reserve Constable Frederick—or, as he was affectionately known, Eric—Lutton was murdered by the IRA outside a National Trust attraction in the village of Moy, in County Armagh. A police radio alert called officers who were on patrol in the area. It told them that a shooting had occurred and that a Renault car had been used as the getaway vehicle. Those officers arrived at the scene as Mr. Lutton was being placed inside the ambulance. They set up a vehicle checkpoint five miles from the incident, at which they stopped a cattle lorry coming from the direction of the shooting.
	Inside that lorry were two brothers, well known smugglers with deep republican connections. The names of those two brothers have been forwarded to the historical inquiries team. As the police questioned the driver, one of the officers looked in the back of the truck. Inside was a Renault car matching the description of the getaway vehicle. The brothers were questioned about that and offered no credible explanation. Both were arrested under section 14 of the prevention of terrorism Act, "on suspicion of being involved in terrorist activity". The two brothers were separated. One took the truck with a police escort to Gough barracks in Armagh, which we all know, and the other was taken in a police vehicle.
	That happened within 30 minutes of the shooting and less than five miles from where it took place. Yet today no record is to be found with the police of those two brothers or their arrest. Did they enjoy protection or immunity from prosecution? It has long been asserted by police officers that that was the case, and that another well-placed officer who was a relative of the two helped, as it were, to "get it fixed" for them. Tonight we have to ask: was that the case?
	As the ambulance carrying Mr. Lutton approached the hospital, a local cleric stopped his car in the middle of the road, blocking its path. He was made to move his car and Mr. Lutton was admitted to hospital, where he died. Why were no charges ever brought against that individual? We do not know whether Eric would have survived—probably not—but impeding the medical assistance of a gravely wounded police officer not only was immoral, but helped to ensure that he would never provide any testimony about who was responsible.
	While at the family home, investigating officers discussed the case in front of Mr. Lutton's wife and family. They identified one Mr. Francie Molloy as a live suspect in the killing. They discussed the need to pursue a thorough investigation of Mr. Molloy. To a man, the investigating officers agreed that that was a vital line of inquiry. All that was discussed openly, in front of Mr. Lutton's wife and family. Molloy was well known to the police, yet none of this was ever fully investigated. Why was he not properly investigated?
	As well as being a suspect in the Lutton case and known to the police, Francie Molloy was well known—this information comes from the police—for a series of sexual indiscretions. That was to rebound on Francie Molloy. He was caught by the security forces in a compromising position. As a result, he was recruited as an informer for the police. He would make regular contact with a handler at a public phone box near a road haulage company in town called Tamnamore, in County Tyrone. During the years that followed, Molloy passed on information to the police in Northern Ireland. That helped them to break open the IRA's notorious east Tyrone brigade. Prior to Molloy's recruitment, the east Tyrone brigade had been virtually impregnable. After it, the brigade suffered setbacks, taking direct hits and losing personnel.
	Any right-thinking person would wish to welcome the fact that the police in Northern Ireland were able to run agents against the IRA and to compromise it. But during that time, even though Molloy was an informer, it is also true that innocent people were attacked, injured and murdered, and he said or did nothing to prevent that. He was less than a willing informer. While he gave over enough information to help to compromise the IRA in east Tyrone, the question still lingers as to whether he gave everything he knew. How many of Molloy's neighbours lived under threat? How many were forced out of their homes, attacked, injured, killed or bereaved while he did nothing? Any good that he might have done by acting as an informer against the IRA, and by helping to compromise the east Tyrone brigade, was more than cancelled out by his callous disregard for the lives of his neighbours.
	Today, Francie Molloy is Deputy Speaker of the Northern Ireland Assembly. He is also the Sinn Fein spokesman on victims. If ever anyone was wholly unsuitable for such a position, it is Francie Molloy. Gerry Adams has said that the truth behind republican informers—or touts, as they are called in Northern Ireland—ought to be told. However, he has described all such people as former republicans. How can this particular tout be a former republican when remains a Sinn Fein MLA and his party's spokesman? How can he be a former republican when he is Sinn Fein's nominee for the position of Deputy Speaker in the Assembly? The denial that runs right to the very top of Sinn Fein is still very evident.
	I have been criticised by some for doing what I am doing here tonight. I want to make it perfectly clear that I am taking this step in order to ensure that a story that needs to be told will be told. The police in Northern Ireland infiltrated the republican movement, and they were helped by agents such as Francie Molloy and others yet to be exposed, whose activities weakened it from within. That the security forces would run agents was only to be expected, and that those agents would be people like Molloy who were usable in that way was predictable. However, the fact that someone such as Molloy chose to allow innocent people to die is reprehensible, and that is why he deserves to be exposed here tonight. I make no apology for doing that.
	There is a clear need to deal with the past in Northern Ireland, and in particular, with the policing of the past. I—and many, if not all, Members of the House—have the highest regard for the brave officers who protected the people from those who were intent on their murder. Today, however, there are many unsolved cases, grieving homes and vacant chairs. Many people do not even know the story of how their loved ones were cut down. We must give that to them.
	When I compare the money thrown at inquiries with the relatively small amount of funding that has been granted to the historical inquiries team, I have to ask whether the money could not have been better spent. We now also have Eames-Bradley consultative group. That group must not be used as a replacement for our competitor against the historical inquiries team. It is also important that there be no simple, one-size-fits-all attempt at a solution. Rather, there must be an approach that allows for individual grief to find expression—and, we hope, eventually some comfort.
	The past in Northern Ireland still cries out for its pain. The Bible contains this lament in verse 11 of chapter 8 of the book of Jeremiah:
	"they have healed the hurt of the daughter of my people slightly, saying Peace, peace; when there is no peace."
	In attempting to bring some kind of healing to the many in Northern Ireland who still carry the painful legacy of our past, we need to ensure that that we do not inflict the same upon them.